POS0260 CHILDHOOD BULLYING AND MUSCULOSKELETAL PAIN IN ADOLESCENCE: A PROSPECTIVE STUDY OF REPORTED PAIN HISTORY AND QUANTITATIVE SENSORY TESTING
Authors: R. Lucas, S. Fraga, S. Soares, M. Talih
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psychosocial circumstances are strongly associated with the onset and prognosis of chronic musculoskeletal (MSK) pain. However, it is unknown they precede, coexist with or follow MSK pain conditions. Bullying during youth is a particularly damaging but modifiable social experience that is known to interfere with health status, potentially including pain memories and responses to noxious stimuli. <h3>Objectives</h3> We aimed to quantify the longitudinal associations between bullying profiles and musculoskeletal pain (reported history and pressure pain sensitivity) in a large population-based cohort of adolescents followed since birth. <h3>Methods</h3> We used data from the 10 and 13 years waves of the Generation XXI birth cohort study based in Porto, Portugal. Data on youth pain history were collected during face to face interviews from parents (age 10) and adolescents (age 13) using the Luebeck pain screening questionnaire. MSK pain was considered present when the participant had recurrent pain in one of the following sites: back, neck, shoulders, upper/lower limbs, hips, or generalized MSK pain. A subsample of the cohort underwent quantitative sensory testing using computerized deep tissue cuff pressure algometry in the legs, which allowed estimating pain detection/tolerance thresholds, and measuring pain intensity ratings. Bullying profiles were computed for the 10 and 13 years waves based on responses to the Bully Scale Survey and participants were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Cross-sectional and longitudinal associations between bullying profiles and reported pain were quantified using relative risks (RR) and 95% confidence intervals (95% CI) obtained using Poisson regression. Associations between bullying and pain sensitivity were estimated using linear regression coefficients and 95% CI. Estimates were adjusted for sex and number of Adverse Childhood Experiences adapted from the questionnaire by Felitti et al. <h3>Results</h3> Among the 4049 adolescents examined, bullying profiles at age 10 were associated with MSK pain at age 13, whereas there were no associations between MSK pain at age 10 and bullying profiles at 13. Cross-sectional associations between bullying and MSK pain history were present at 10 and 13 years. When compared to adolescents "not involved" in bullying, those who reported being victims at age 10 had higher risk of reporting MSK pain at age 13: RR (95% CI) 1.28 (1.06, 1.55) for "victims only" and 1.30 (1.06, 1.58) among "both victims and aggressors" (Figure below). "Aggressors only" did not show clear differences in terms of pain history. Among the 1727 adolescents who underwent cuff pressure algometry, those who were "victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years [linear regression coefficients (95% CI): -1.81 (-3.29, -0.33) for detection and -2.73 (-5.17, -0.29) for tolerance], as well as higher pain intensity ratings [0.37 (0.07, 0.68) and 0.39 (0.06, 0.72)], when compared with adolescents not involved in bullying. No differences were seen for the remaining bullying profiles. <h3>Conclusion</h3> Our study provides prospective evidence that bullying victimization is more likely to lead to negative reported MSK pain experiences than the reverse. Bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with somatosensory responses to painful stimuli. <h3>Acknowledgements</h3> This work was supported by FOREUM - Foundation for Research in Rheumatology (Career Research Grant). Cohort funded by EPIUnit at ISPUP, Universidade do Porto (UID/DTP/04750/2019), Regional Department of the Portuguese Ministry of Health and Calouste Gulbenkian Foundation. MT was funded by the ERDF, through the North Regional Operational Program in the framework of the project HEALTH-UNORTE (NORTE-01-0145-FEDER-000039). Graven-Nielsen et al (CNAP, Aalborg University) provided algometry protocols. <h3>Disclosure of Interests</h3> None Declared.